Australian Critical Care最新文献

{"title":"Prevalence and variability in use of physical restraints in intensive care units: A systematic review and meta-analysis","authors":"Akbar Zare-Kaseb MN ,&nbsp;Sogand Sarmadi MN ,&nbsp;Neda Sanaie PhD ,&nbsp;Amir Emami Zeydi PhD","doi":"10.1016/j.aucc.2025.101210","DOIUrl":"10.1016/j.aucc.2025.101210","url":null,"abstract":"<div><h3>Background</h3><div>Given the varying perspectives on the use of physical restraint (PR) over the past decades and the provided protocols to minimise its occurrence in intensive care units (ICUs), a comprehensive study was deemed necessary to examine the prevalence and variation of PR use in ICUs.</div></div><div><h3>Objective</h3><div>The aim of this study was to estimate the overall proportions of PR utilised in adult ICUs whilst examining the various factors contributing to the variability of these estimates.</div></div><div><h3>Methods</h3><div>A search of five databases (PubMed, Cochrane Library, Scopus, Embase, and Web of Science) was performed. Studies published in English and available online from inception to December 18, 2024, were included. A pooled estimate with a 95% confidence interval was calculated, and the data were represented by the random-effect model. Analysis was performed using the STATA statistical software (version 17).</div></div><div><h3>Results</h3><div>The meta-analysis included 39 studies, with a sample size of 21 665 patients. The overall prevalence of patients exposed to PRs was 41.6% (95% confidence interval: 33.8%–49.5%). The heterogeneity was significantly high (I² = 99.61%), and the Q Cochrane test for homogeneity was significant (p value &lt; 0.001), indicating substantial variability between studies. Subgroup analysis regarding the continent and restraint method contributed to a lowered heterogeneity.</div></div><div><h3>Conclusions</h3><div>There was considerable variation in reported estimates of PR prevalence in adult ICUs. Despite valid guidelines and recommendations supporting the reduction of PR, the results of our study show its significant prevalence. Additionally, our study demonstrated a relationship between PR use and delirium, sedation use, and mechanical ventilation. This study emphasises the importance of managing and focussing on PRs in ICUs. Also, it is crucial to evaluate barriers to guideline implementation.</div></div><div><h3>Registration</h3><div>The systematic review protocol has been prospectively registered in the International Prospective Register of Systematic Reviews: CRD42024566480.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101210"},"PeriodicalIF":2.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143637508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of prophylactic non-invasive ventilation on weaning: A systematic review with meta-analysis","authors":"Helder B. Duarte PT ,&nbsp;Ueidson J.S. Batista PT, BPT ,&nbsp;Paula M. Oliveira PT, BPT ,&nbsp;Dimitri Gusmao-Flores MD, PhD ,&nbsp;Bruno P. Martinez PT, PhD","doi":"10.1016/j.aucc.2025.101199","DOIUrl":"10.1016/j.aucc.2025.101199","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study was to evaluate the effects of prophylactic non-invasive ventilation (NIV) on reintubation, postextubation respiratory failure, length of stay (LOS), and mortality in the intensive care unit (ICU).</div></div><div><h3>Method</h3><div>A systematic review of the databases followed by meta-analysis was conducted. We included randomised or quasi-randomised clinical trials conducted in adults, with a mechanical ventilation time &gt;48 h, who had good performance in the spontaneous breathing test and compared the use of prophylactic NIV with oxygen supplementation.</div></div><div><h3>Results</h3><div>Eleven studies were included in this review. There was a difference in favour of prophylactic NIV for the outcome reintubation (odds ratio [OR]: 0.49; 95% confidence interval [CI]: 0.32, 0.74), ICU mortality (OR: 0.39; 95% CI: 0.21, 0.71), hospital mortality (OR: 0.53; 95% CI: 0.33, 0.85), ICU LOS (median [MD]: -2.86; 95% CI: −5.47, −0.24), and postextubation respiratory failure development (OR: 0.28; 95 % CI: 0.12, 0.67). There was no difference noted for hospital LOS (MD: -0 0.42; 95% CI: -3.42, 2.59). In the subgroup analysis, the use of rescue NIV, mainly in the control group, showed no statistically significant difference in the outcomes.</div></div><div><h3>Conclusion</h3><div>The use of prophylactic NIV reduced reintubation rates, ICU and hospital LOS, and mortality. These findings support the recommendation for its use in daily practice. Rescue NIV may have reduced the reintubation rate in control group who underwent the procedure.</div></div><div><h3>Prospero registration</h3><div>CRD42022381099.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101199"},"PeriodicalIF":2.6,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Harnessing machine learning for predicting successful weaning from mechanical ventilation: A systematic review","authors":"Fatma Refaat Ahmed PhD, RN ,&nbsp;Nabeel Al-Yateem PhD, RN ,&nbsp;Seyed Aria Nejadghaderi MD, MPH ,&nbsp;Ahmad Rajeh Saifan PhD, RN, CNS ,&nbsp;Sally Mohammed Farghaly Abdelaliem PhD, RN, FHEA ,&nbsp;Mohannad Eid AbuRuz PhD, RN","doi":"10.1016/j.aucc.2025.101203","DOIUrl":"10.1016/j.aucc.2025.101203","url":null,"abstract":"<div><h3>Background</h3><div>Machine learning (ML) models represent advanced computational approaches with increasing application in predicting successful weaning from mechanical ventilation (MV). Whilst ML itself has a long history, its application to MV weaning outcomes has emerged more recently. In this systematic review, we assessed the effects of ML on the prediction of successful weaning outcomes amongst adult patients undergoing MV.</div></div><div><h3>Methods</h3><div>PubMed, EMBASE, Scopus, Web of Science, and Google Scholar electronic databases were searched up to May 2024. In addition, ACM Digital Library and IEEE Xplore databases were searched. We included peer-reviewed studies examining ML models for the prediction of successful MV in adult patients. We used a modified version of the Joanna Briggs Institute checklist for quality assessment.</div></div><div><h3>Results</h3><div>Eleven studies (n = 18 336) were included. Boosting algorithms, including extreme gradient boosting (XGBoost) and Light Gradient-Boosting Machine, were amongst the most frequently used methods, followed by random forest, multilayer perceptron, logistic regression, artificial neural networks, and convolutional neural networks, a deep learning model. The most common cross-validation methods included five-fold and 10-fold cross-validation. Model performance varied, with the artificial neural network accuracy ranging from 77% to 80%, multilayer perceptron achieving 87% accuracy and 94% precision, and convolutional neural network showing areas under the curve of 91% and 94%. XGBoost generally outperformed other models in the area under the curve comparisons. Quality assessment indicated that almost all studies had high quality as seven out of 10 studies had full scores.</div></div><div><h3>Conclusions</h3><div>ML models effectively predicted weaning outcomes in adult patients undergoing MV, with XGBoost outperforming other models. However, the absence of studies utilising newer architectures, such as transformer models, highlights an opportunity for further exploration and refinement in this field.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101203"},"PeriodicalIF":2.6,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143579552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multicentre prospective study to establish a risk prediction model on pressure injury in the neonatal intensive and intermediate care units","authors":"Felice Curcio RN, PhD ,&nbsp;Manuel Vaquero-Abellán MD, PhD ,&nbsp;Alfonso Meneses-Monroy RN, PhD ,&nbsp;Domingo de-Pedro-Jimenez RN, OHN, PhD ,&nbsp;Cesar Ivan Aviles-Gonzalez RN, PhD ,&nbsp;Manuel Romero-Saldaña RN, PhD","doi":"10.1016/j.aucc.2025.101204","DOIUrl":"10.1016/j.aucc.2025.101204","url":null,"abstract":"<div><h3>Background</h3><div>The association between pressure injuries (PIs), risk factors, and preventive measures in hospitalised infants has not been extensively studied.</div></div><div><h3>Objective</h3><div>The aim of this study was to explore the incidence of PIs in hospitalised infants, the risk factors and preventive measures associated with them and construct a risk prediction model.</div></div><div><h3>Methods</h3><div>A multicentre, prospective, cohort study was conducted in infants hospitalised in two level III neonatal intensive care units and two neonatal intermediate care units in Italy. Sociodemographic and clinical information, the Italian-Neonatal Skin Risk Assessment Scale (i-NSRAS) scale score, presence of medical devices, risk factors, preventive measures, and PI characteristics were collected and evaluated using univariate and multivariate analyses. In addition, the decision tree technique was applied to analyse variables that best explained the occurrence of PIs in the neonatal population.</div></div><div><h3>Results</h3><div>A sample of 209 infants were included. A total of 62 PIs occurred in 40 infants; the cumulative incidence was 19.1%. In intensive care units, the cumulative incidence was 26.4%, whilst in intermediate care units, it was 8.3%. The PIs were categorised as stage I, 38.7%; stage II, 53.2%; and stage III, 8.1%. The most frequent location was the nose, 46.8%. Multivariate analysis identified the following risk factors: i-NSRAS score (relative risk [RR]: 0.81; 95% confidence interval [CI]: 0.69–0.94; p = 0.007); sedation (RR: 7.35; 95% CI: 1.67–32.40; p = 0.008), local pressure relief devices (RR: 4.41; 95% CI: 1.3 5–14.38; p = 0.014), and fasting (RR: 5.04; 95% CI: 1.37–18.47; p = 0.015). The decision tree detected that an i-NSRAS score ≤17 and the local pressure relief devices were the variables that best explain the appearance of PIs in infants.</div></div><div><h3>Conclusion</h3><div>The incidence of PIs in infants is high, especially in critically ill ones, and is mainly due to the presence of medical devices. The constructed clinical tree model can easily predict the risk of PI in hospitalised infants and, consequently, apply effective preventive strategies. To assign preventive measures based on the risk assessed according to objective criteria, we suggest the application of predictive models as part of a strategic PI prevention plan.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101204"},"PeriodicalIF":2.6,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143579540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of compassion fatigue, structural empowerment, and psychological empowerment on the caring behaviours of intensive care unit nurses in China: A structural equation modelling analysis","authors":"Chuanru Zhou RN, MN ,&nbsp;Xia Huang RN, PhD ,&nbsp;Ting Yu RN, MN ,&nbsp;Cong Wang RN, MN ,&nbsp;Yan Jiang RN, PhD","doi":"10.1016/j.aucc.2024.101166","DOIUrl":"10.1016/j.aucc.2024.101166","url":null,"abstract":"<div><h3>Background</h3><div>Caring behaviours play a pivotal role in nursing. The negative correlation between caring behaviours and compassion fatigue in the intensive care unit (ICU) has been extensively researched. Nevertheless, considerable gaps persist in comprehending the associations of psychological empowerment and structural empowerment with outcomes, particularly in the highly stressful environment of the ICU.</div></div><div><h3>Objectives</h3><div>The aim of this study was to determine how compassion fatigue, structural empowerment, and psychological empowerment impact the caring behaviours of ICU nurses in China via a structural equation modelling analysis.</div></div><div><h3>Design</h3><div>A cross-sectional study through convenience sampling was conducted in the ICU of 24 hospitals in China from February to June 2021.</div></div><div><h3>Methods</h3><div>A self-designed demographic questionnaire, the Chinese version of the Caring Behaviors Inventory, the Chinese version of the Compassion Fatigue Short Scale, the Chinese version of the Conditions of Work Effectiveness Questionnaire-II, and the Chinese version of the Psychological Empowerment Questionnaire-12 were used to survey ICU nurses.</div></div><div><h3>Results</h3><div>A total of 450 ICU nurses were recruited. The final model showed a good model fit. In the ICU nurse population, compassion fatigue (<em>β</em> = −0.582; 95% confidence interval: [−0.686, −0.455]) had a direct negative relationship with caring behaviours, whereas both structural empowerment (β = 0.448; 95% confidence interval: [0.372, 0.572]) and psychological empowerment (β = 0.438; 95% confidence interval: [0.333, 0.563]) had indirect positive associations with caring behaviours through compassion fatigue.</div></div><div><h3>Conclusions</h3><div>Our findings revealed a direct negative association between compassion fatigue and caring behaviours, whereas both structural empowerment and psychological empowerment are indirectly positively associated with caring behaviours through compassion fatigue amongst ICU nurses in China. Our research revealed that positive improvements in structural empowerment and psychological empowerment were associated with enhancements in compassion fatigue mitigation and the fostering of caring behaviours amongst ICU nurses in practice.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101166"},"PeriodicalIF":2.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143552670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Woke ideology or accurate scientific reporting: Censorship in research","authors":"Andrea P. Marshall RN, PhD,&nbsp;Thomas Buckley RN, PhD,&nbsp;Rinaldo Bellomo AO, MBBS (Hons), MD, PhD, FRACP, FCICM","doi":"10.1016/j.aucc.2025.101208","DOIUrl":"10.1016/j.aucc.2025.101208","url":null,"abstract":"","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101208"},"PeriodicalIF":2.6,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143471502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wellbeing as perceived and experienced by intensive care unit nurses: An interpretive qualitative analysis","authors":"Annabel Levido RN, M Applied Management (Nurs) ,&nbsp;Fiona Coyer RN, PhD ,&nbsp;Samantha Keogh RN, PhD ,&nbsp;Liz Crowe BSocWk, PhD","doi":"10.1016/j.aucc.2025.101202","DOIUrl":"10.1016/j.aucc.2025.101202","url":null,"abstract":"<div><h3>Background</h3><div>There is an intensive care nursing workforce crisis. Intensive care unit (ICU) nurses provide highly technical and compassionate care to the growing number of ICU patients. Urgent attention is required for ICU nursing workforce planning and development. The promotion of wellbeing is positively linked to recruitment, retention, and workplace satisfaction. Exploration of wellbeing from an intensive care nurse's perspective is required to ensure an in-depth understanding to guide future interventions and research.</div></div><div><h3>Objectives</h3><div>The aim of this study was to explore ICU nurses’ perceptions of wellbeing in the context of their work.</div></div><div><h3>Methods</h3><div>This study utilised an inductive, interpretive qualitative design, involving semistructured focus groups with ICU nurses employed within a large metropolitan unit in Australia. Focus groups were audio recorded, transcribed verbatim, and analysed using a thematic approach.</div></div><div><h3>Results</h3><div>A total of 31 critical care nurses participated in five semistructured focus groups. Four themes were evident: (i) intergenerational wellbeing; (ii) the evolution of wellbeing; (iii) the illusion of balance; and (iv) meaning and purpose.</div></div><div><h3>Conclusion</h3><div>This research explores the perceptions of wellbeing from an intensive care nurse's perspective. The four identified themes provide a comprehensive understanding of this topic from a unique viewpoint. This deep understanding is imperative for future research and the generation of meaningful interventions to promote wellbeing, with a goal to increase wellbeing and longevity of the intensive care nursing workforce.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101202"},"PeriodicalIF":2.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143438015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Employer-provided wellbeing support for nurses working in intensive care units: A national cross-sectional study","authors":"Yuzi Zhou RN, MAdvN ,&nbsp;Pauline Wong RN, PhD ,&nbsp;Angelique Clarke RN, MN (critical care) ,&nbsp;Rebecca J. Jarden RN, PhD ,&nbsp;Wendy Pollock RN, PhD, RM, FACCCN","doi":"10.1016/j.aucc.2025.101200","DOIUrl":"10.1016/j.aucc.2025.101200","url":null,"abstract":"<div><h3>Background</h3><div>Intensive care units are characterised as high-stress work environments that may negatively affect nurses’ wellbeing. Employer-provided support has a crucial role in reducing burnout and improving wellbeing.</div></div><div><h3>Objective</h3><div>The aim of this study was to examine wellbeing supports routinely offered by employers of nurses working in intensive care units and examine the relationships amongst perceived organisational support, wellbeing, and burnout.</div></div><div><h3>Methods</h3><div>A cross-sectional study of nurses working in Australian intensive care units was conducted from 4 to 19 September 2023. A web-based survey was distributed via the Australian College of Critical Care Nurses and social media, with snowball sampling. Validated tools for perceived organisational support, subjective wellbeing, and burnout were used.</div></div><div><h3>Results</h3><div>Of 668 responses, 632 met inclusion criteria for analysis (94.6%). Education and training were the most common supports recognised by nurses (63.4%, <em>n</em> = 401). The most helpful support was childcare assistance (M = 3.17, standard deviation [SD] = 1.38). Higher levels of perceived organisational support were associated with better subjective wellbeing (<em>r</em> = 0.20; p &lt; 0.001). Perceived organisational support was higher for nurses without burnout (M = 4.15, SD = 0.89) than for those with burnout (M = 3.64, SD = 0.85; t [625] = 7.43, <em>p</em> &lt; 0.001, two-tailed). For every one-point increase in the mean value of perceived organisational support, nurses were 56% less likely to report experiencing burnout than those who perceived lower organisational support (B = −0.81, <em>p</em> &lt; 0.001, odds ratio = 0.44, 95% confidence interval: 0.35–0.56). The strongest predictor of reporting burnout was engaging in an education/clinical support job role (B = 0.88, <em>p</em> = 0.04, odds ratio = 2.41, 95% confidence interval: 1.04–5.60).</div></div><div><h3>Conclusions</h3><div>Nurses working in Australian intensive care units perceived employer-provided wellbeing support to be inadequate. Perceived organisational support is a modifiable independent predictor of burnout, suggesting that employers need to work with nurses to improve wellbeing supports.</div></div><div><h3>Registration</h3><div>Not registered.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101200"},"PeriodicalIF":2.6,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143377703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antidepressant use, but not polypharmacy, is associated with worse outcomes after in-hospital cardiac arrest in older people","authors":"Gustavo Martins Ferreira BN ,&nbsp;João Carlos Clarck Barros BN ,&nbsp;Nayane Maria Vieira MN ,&nbsp;Isabelle de Almeida Souza BN ,&nbsp;Asiya Shalova BN ,&nbsp;Bertha Furlan Polegato MD, PhD ,&nbsp;Leonardo Antônio Mamede Zornoff MD, PhD ,&nbsp;Sergio Alberto Rupp de Paiva MD, PhD ,&nbsp;Paulo José Fortes Villas Boas MD, PhD ,&nbsp;Danilo Martins MD, PhD ,&nbsp;Edson Luiz Favero Junior MD, PhD ,&nbsp;Taline Lazzarin MD ,&nbsp;Jemima Collins MD, PhD ,&nbsp;Paula Schmidt Azevedo MD, PhD ,&nbsp;Marcos Ferreira Minicucci MD, PhD","doi":"10.1016/j.aucc.2025.101201","DOIUrl":"10.1016/j.aucc.2025.101201","url":null,"abstract":"<div><h3>Background</h3><div>It is already known that age and some chronic diseases are associated with worse outcomes after in-hospital cardiac arrest (IHCA). Usually, patients with two or more chronic diseases are treated with multiple medicines, which is commonly referred as polypharmacy (five or more medications). The objective of this study was to evaluate the association between polypharmacy and antidepressant use before hospital admission with return of spontaneous circulation (ROSC) and in-hospital mortality in IHCA.</div></div><div><h3>Methods</h3><div>This retrospective study included patients over 18 years of age with IHCA, attended by the rapid response team in hospital wards, from March 2018 to September 2023. The exclusion criteria were the absence of information regarding polypharmacy, pregnancy, and the presence of an express “do-not-resuscitate order”. Data were collected from the electronic medical records.</div></div><div><h3>Results</h3><div>A total of 578 patients with IHCA were evaluated; 42 patients were excluded due to the absence of information regarding polypharmacy and 24 due to “natural death permission”. Thus, we included 512 patients in the analysis. The mean age was 64.4 ± 14.9 years; 52.3% were male, and 54.5% were older people. Polypharmacy was prescribed for 50.8% of patients, 48.4% had ROSC, and in-hospital mortality was 92.0%. In logistic regression models, the polypharmacy regimen use in the older population was not associated with ROSC (odds ratio [OR]: 1.122; 95% confidence interval [CI]: 0.660–1.906; p: 0.672) or mortality (OR: 1.185; 95% CI: 0.170–8.260; p: 0.864). Regarding antidepressant use, it was associated with lower rates of ROSC (OR: 0.412; 95% CI: 0.183–0.925; p: 0.032) but was not associated with mortality in older people (OR: 1.682; 95% CI: 0.129–21.996; p: 0.692).</div></div><div><h3>Conclusions</h3><div>In conclusion, polypharmacy regimen was not associated with ROSC and in-hospital mortality; however, antidepressant use was associated with lower rates of ROSC only in older patients.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101201"},"PeriodicalIF":2.6,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding crisis needs among family caregivers of patients in critical care: A qualitative analysis","authors":"Amanda C. Blok RN, PhD ,&nbsp;Thomas S. Valley MD, MSc ,&nbsp;Lauren E. Gauntlett MPH ,&nbsp;Jacquelyn Miller MA ,&nbsp;Kyra Lipman BS ,&nbsp;Sarah L. Krein RN, PhD","doi":"10.1016/j.aucc.2024.101168","DOIUrl":"10.1016/j.aucc.2024.101168","url":null,"abstract":"<div><h3>Background</h3><div>Family caregivers often experience shock and disorientation when a patient is admitted to critical care. Developing interventions to assist caregivers during this crisis requires a more in-depth understanding of their needs.</div></div><div><h3>Objective</h3><div>Our aim was to understand family caregivers' needs during a patient's critical care admission and early hospitalisation and differences in needs by caregiver anxiety level.</div></div><div><h3>Methods</h3><div>We conducted a descriptive mixed-method study. Forty semistructured interviews were conducted with family caregivers of mechanically ventilated critical care patients. The Hospital Anxiety and Depression Scale was also administered. Crisis theory was used to guide this analysis. The data were analysed by content analysis and then stratified by anxiety level to examine differences across groups. Consolidated Criteria for Reporting Qualitative Research were followed.</div></div><div><h3>Setting</h3><div>Two intensive care units at a large, tertiary academic medical centre were a part of this study.</div></div><div><h3>Findings</h3><div>Caregivers at all anxiety levels described needs involving information and emotional processing, social support, and self-care, with differences across anxiety groups. Caregivers with anxiety and borderline anxiety expressed limited capacity to think past the current moment, whilst caregivers with low anxiety actively used information to consider next steps and prepare others. Emotional processing appeared more limited in the anxiety and borderline-anxiety groups. Whilst most caregivers reported receiving some degree of social support, some caregivers with anxiety noted family tension, whilst caregivers with borderline and low anxiety had a wider variety of supportive relationships. Caregivers with anxiety reported distress influenced their self-care, whilst caregivers with borderline and low anxiety received tangible help from other family members for self-care.</div></div><div><h3>Conclusion</h3><div>Family caregivers of critical care patients experience needs during early hospitalisation, although the specific needs differ by caregiver anxiety level.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101168"},"PeriodicalIF":2.6,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}